There’s one thing that links every patient I see as a pain management specialist: All they want is relief. And they want it in whatever way is going to be the most effective and least disruptive to their lives. And anyone in this role can tell you that that’s a big responsibility and a tall order. This job isn’t simply about reducing pain – it’s about giving people a life back that isn’t defined by that pain.
The fact of the matter is that many treatments we’ve relied on throughout the years to address chronic pain have come with major side effects or weren’t nearly as effective as they needed to be. The good news is that the last decade has seen major advancement in how we treat chronic pain. No one can deny that we’ve had to reconsider opioids as the first line of care of chronic pain. That reckoning has had a follow-on effect of increasing interest, excitement, and focus on pain management options that were otherwise ignored, like spinal cord stimulation (SCS) where an implanted device sends low levels of electricity into the spinal cord to relieve pain.
My first encounter with SCS came while I was a resident at the Mayo Clinic in the mid-2000s. At the time, it was only used for leg pain, but I was immediately taken in by the possibilities I saw. This was a very different approach to pain – it wasn’t simply about reducing it but in some cases, it could change the pattern of disease. On top of that, it was effective without the same side effects and stigma that come with opioids. The challenge though was that its use was limited to only a few conditions.
Those limitations felt a bit like a challenge. I immediately wanted to know just how else those of us in pain management might use SCS. And it turns out I wasn’t the only person asking these questions. A few years later, a company showed that they were able to use 10,000 Hz SCS to treat back pain. For SCS, this was a big moment – it was a completely new treatment modality, not simply a refinement on an existing treatment.
For me, this is what I’d been waiting for: here was evidence that this promising technology did have potential outside of leg pain. That potential is invaluable to me because as a physician – especially working with people living with chronic pain – the greatest thing I can give someone is hope. Being able to say that there is not just a treatment that works generally, but one that works for them in a way that lets them live their lives is why I do this job.
Right now, we have a chance to rethink how we provide pain relief because spinal cord stimulation is truly moving from being a last-resort treatment with limited indications to something with a far broader range of uses and applicability earlier in the treatment plan. SCS is more versatile than ever before – we can offer more types of stimulation that can dial in the right therapy for each patient. Having those options means more chances to find relief that works.
And for patients, SCS offers some unique benefits. We’ve all seen the growing interest in remote care over the past year and a half, borne out of necessity from the pandemic. SCS therapy can now be optimized remotely, letting patients connect with doctors and company representatives to manage their pain from their own homes.
On top of that, the horizon for what SCS can be used for continues to expand. For instance, with their 10 kHz stimulation approach, Nevro recently received the FDA’s first specific indication for using SCS to treat painful diabetic neuropathy – a condition that was not even on the radar for SCS until recently. This sort of progress means we can also go back and look at patients we may not have been able to help in the past but who may be candidates for SCS now.
As practitioners, we deliver hope by being open to new ways and approaches to reducing and managing pain. Frankly, we should have been doing more of this work as the downsides of opioids came into focus. We should never expect to settle for “good enough” or continue doing something simply because it’s how we’ve always done it. We owe it to ourselves, our patients, and our colleagues to constantly question if there are better ways to deliver on the goal of reducing pain.
Bryan C. Hoelzer is an anesthesiologist and pain management specialist.
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